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Cẩm nang huyết học - yhocthuchanh2015 PDF
Cẩm nang huyết học - yhocthuchanh2015 PDF
CM NANG
HuYT HC
CUN SCH U TAY CA L VN CNG
Cun sch l tt c nhng g mnh hc tp, tch ly v nghin
cu c trong sut qu trnh hc tp mn Huyt hc. N bao
gm hu ht nhng kin thc thit thc ca mn Huyt hc v
Truyn mu. Hn na , kin thc trong cun sch c vit
di gc ca mt sinh vin nn s tr nn gn gi v d
hiu hn rt nhiu so vi cc Gio s Tin s . Bn hon ton
c th yn tm vi lng kin thc trong cun sch .Bi n
khng ch a ra nhng l thuyt c ng , y m n cn
km theo c gii thch ngha ca tng xt nghim, tng thay
i trong cc trng hp bnh l. Chnh y l ci m mnh
tm c nht cun cm nang ny. Bi ch khi bn hiu bn
mi gii thch c , ch khi bn gii thch c bn mi c
th nh lu c.V ch khi nh lu c bn mi c th hc
tp v lm vic tt c.
L VN CNG
Lp i hc xt nghim 4b i hc k thut y t Hi Dng
Th T, 24 Thang By 2013
CM NANG HUYT HC NG MU
L VN CNG
2
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
3
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
CM NANG
HUYT HC
NG MU
L THUYT NG MU V CC XT NGHIM LIN QUAN
Cun sch u tay ca :
L Vn Cng- i hc k thut y t Hi Dng
Sch ch tng khng bn
KHNG G L KHNG TH
Khi mi chuyn tr nn kh khn , hy t hi bn thn , mnh phi lm g
thay i cc din , mnh phi lm g ci thin tnh hnh.V hy hnh ng
bn nh. ng nn nh bn v ti, bi trn ng i , ch lc vp ng mi bit
mnh ang sai. ng sng trong nhng hoi nim p ca qu kh , m hy
vch ra cho mnh mt tng lai sng sa pha trc.Chc bn v ti thnh cng
trong hc tp v cuc sng
L Vn Cng
L VN CNG
4
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
5
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
6
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
LI M U
Xut phat t nim am m vi mn Huyt hc , v cng mt phn mun khng nh li
kin thc m mnh tip thu c trong sut qua trnh hc tp i hc. Mnh dc ht
thi gian v cng sc t tay vit ln cun Cm nang huyt hc . B cm nang gm
gm 4 cun l 4 phn ca huyt hc : Huyt hc t bo , Huyt hc ng mu , Huyt
hc Min dch v truyn mu , Huyt hc chuyn su v cc vn cn bit.
Cun sach gm tt c nhng g mnh hc tp, tch ly v nghin cu c , trong sut qua
trnh hc tp mn Huyt hc. N bao gm hu ht nhng kin thc thit thc ca mn
Huyt hc v Truyn mu. Hn na , cun sach c vit di gc ca mt sinh vin
nn n s tr nn gn gi v d hiu hn rt nhiu so vi cac Giao s , Tin s .Bn hon
ton c th yn tm vi lng kin thc trong cun sach. Bi n khng ch a ra nhng l
thuyt c ng, y , m n cn km theo c gii thch ngha ca tng xt nghim ,
tng thay i trong cac trng hp bnh l.Chnh y l cai m mnh tm c nht cun
sach ny. Bi ch khi bn hiu bn mi gii thch c , ch khi gii thch c bn mi
nh c th nh lu c. V ch khi nh lu c bn mi hc tp v lm vic tt c.
Bn cnh nhng u im trn th cun sach ny cn c rt nhiu thiu st .Mc d mnh
c gng ht sc r soat v chnh sa , song cng khng th tranh c sai st v cach
trnh by v li chnh t. c bit , y ch l nhng nghin cu nho nh ca bn thn da
vo cc thng tin mnh c sch v nghin cu cc ti liu trn Internet , n cha c
thy c v nhng ngi c uy tn kim chng tnh chnh xc ca vn c cp. V vy
mnh rt mong c bn c v thy c chn thnh ng gp v ni dung ca cun sach,
n tr nn hon ho v tin cy hn. Qua , mnh c th tip thu c nhng kin thc mi
sa cha c nhng hiu bit sai lm trong kin thc cp.
Cun sach ny dnh ring cho L Vn Cng , Lp HXN 4b ,i hc k thut y t Hi
Dng. Nn khng bn Khng mua - Khng cho mn nu khng c s ng ca
mnh. Nu bn c quan tm ti nhng kin thc trong cun sach, mun tm hiu thm
thng tin v c lng ng gp cho cun sach , bn hon ton c th mn mnh c v chp
li nu cn. Mnh b rt nhiu thi gian bn cai may tnh , b nhiu trn bng a
Premier League ca Manchester United v nhng trn cu C1 ny la( i bng con cng
ca bn ang m bn li ang hc th tht l kh chu ht mc, hn na li l nhng
dp cui tun , lc m tt c mi ngi u chi ). c bit N l a con tinh thn ca
mnh, mnh khng mun ai xm phm n. Mnh khng mun cng sc , thi gian , sc
khe ca mnh mang ra quan photo mt cach r mt, mua ban-trao i mt cach min ph
v thoi mai nh bao quyn sach khac.Mong c mi ngi tn trng. Xin cm n!!!!!
Hi Dng , ngy 1 thang 5 nm 2013
L VN CNG
7
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
8
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
MC LC
I-CM MU BAN U
1. Cc yu t tham gia CMB10
2. Cc XN nh gi CMB.12
_ Nghim php dy tht12
_ Thi gian mu chy ( PP Duke )...13
_ XN co cc mu...14
II- NG MU
1. iu ha qu trnh M-Cc yu t tham gia.15
2. Cc giai on ca qu trnh ng mu19
3. Cc XN kho st qu trnh ng mu.24
_ Thi gian mu ng trn lam.24
_ Thi gian mu ng trn ng nghim..25
_ Thi gian Howell26
_ Thi gian APTT.27
_ Thi gian TT...33
_ Bng tm tt cc XN ng mu34
L VN CNG
9
Khoa xt nghim
i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
IV- BNH NG MU
1. Hi chng ng mu ri rc lng mch (DIC)..71
2. Hi chng xut huyt gim tiu cu huyt khi (TTP).74
3. Hi chng tan mu Ure huyt cao (HUS).75
4. Tnh trng tng ng-Bnh huyt khi..77
5. ng mu thai nghn...82
6. Bnh Hemophilie ..83
7. Bnh ri lon ng mu mc phi.85
_ Thiu VTM K85
_ Bnh gan.86
_ Bnh h thng Lupus ban (SLE).87
_ Ri lon ng mu sau truyn mu d tr t89
_ Bnh vim thnh mch d ng89
8. Bin lun xt nghim ng mu.90
9. Cc gi tr M cho cuc m an ton. 91
10. Tm hiu c ch v ng dng mt s cht-thuc chng ng
_ Heparin..92
_ Natricitrat..92
_EDTA ( Ethylene diamin tetraacetic acid )..93
_ Wafarin ( thuc c ch VTM K ng ung )94
_ Aspirin.94
11.Bng tr s bnh thng-bt thng ca cc XN ng-cm mu.95
12.Tr s bnh thng ca cc yu t tham gia ng-cm mu v TSH.96
L VN CNG
10
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
CM MU BAN U
I. 3 YU T
1. Thnh mch
Ni mch :
_ Cu to : lp n bo , lt ph mt trong ca mch mau
_ Chc nng :
+) Ngn cch dng mu vi t chc khc
+) Chng sinh huyt khi nh heparin sulphat b mt ni mc
+) c ch cc enzyme M nh glycosamino glycan
+) Chng dnh v ngng tp tiu cu nh ADP-ase ging ha ADP
+) Cha thrombomudulin hot ha protein C ( ging ha bt hot Va , VIIIa ) ,
to ra Protein S ( ng yu t protein C , vai tr tng t Pro C )
+) To ra plasminogen khi ng qu trnh TSH
+) SX yu t Willebrand l cht keo sinh hc , gn TC vi Collagen thnh mch
Lp di ni mch
_ Cu to : collagen , Willebrand , Fibrionectin , vi si , si n hi
_ Chc nng : Lp din tch gy ng , hot ha TC v yu t tip xc , khi
lp ni mch b tn thng.
2. Tiu cu
_ Cu to : Mng TC + NSC
+) Mng TC :
Lp kp phospholipid (PL) : ni din ra mt s hot ng M
H thng knh m :gii phng cac ht trong NSC v tng din tch t.xc b mt ca TC
+) NSC : h thng vi ng , vi si , ng dy c ,cac ht : ht c (ADP , Ca2+ ,
serotonin ),ht (PDGF , Ca2+ , Willebrand , Fibrinogen , Fibrionectin ,
Thromboglobulin), thrombosthenin ( protein co ca TC )
L VN CNG
11
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Chc nng :
+) Tham gia qu trnh CMB : Nh kh nng dnh- ngng tp , gii phng cac ht
trong NSC.
+) Tham gia qt M : nh yu t 3 PL ca TC cn thit cho s hot ha yu t
VIIa, Xa , Iia.
+) Tham gia giai on co cc mu : nh thrombosthenin trong NSC ca TC
+) Bo v thnh mch : lm non ha TB ni mch , cng c lp ni mch qua yu t
tng trng PDGF
+) p ng vim v thc bo
II.
CC GIAI ON CMB
1. Co mch
L VN CNG
12
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
S CM MU BAN U
( Ngun : http://xetnghiemdakhoa.com )
III.
1.
CC XT NGHIM NH GI CMB
Nghim php dy tht ( sc bn thnh mch )
_ Nguyn tc XN : To 1 ap lc ln mch mau ngn cn dng mau chy v , cac
mch nh v yu s v , HC thoat ra ngoi , to nn cac nt xut huyt . m s nt
xut huyt anh gia sc bn ca thnh mch
_ Mc ch ngha XN :Kho sat qt cm mau ban u (CMB ) , anh gia cht
lng ca thnh mch
_ Nhn nh kt qu :
L VN CNG
13
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Tin hnh :
+ ) Dng c : kim chch , bng , giy thm, ng h
+) Ha cht : Cn 900 ( ete ) bay hi nhanh , khng lm nh hng mch mu xung
quanh v tr chc.
+) Quy trnh:
B1: Sat khun v tr chc i 1-2 cho cn kh
B2: Chch kim vung gc mt phng dai tai( su 2 di 5 ) v bm ng h
B3: Thm mau cho BN , 30s /1 ln , n khi khng thm c bm ng h dng
li ,ghi kt qu lm trn xung.
Ch :
_ Nhn nh kt qu
Xem video quy trnh ti a ch
+) Bnh thng : 1-4
http://www.youtube.com/watch?v=wmQrqXJCAso
+) Ko di : >6
+) Nghi ng : 4-6 khi phi tin hnh li vi tai kia hoc dng pp Ivy
L VN CNG
14
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
3. Co cc mu
_ Nguyn tc XN : Mau ly ra khi c th s ng li nh hnh thnh si Fibrin , si
Fibrin m ly cac thnh phn hu hnh ca mau ri co rt li tach khi phn huyt thanh.
_ Mc ch ngha : Kho sat qua trnh CMB , qua anh gia cht lng v s
lng ca tiu cu , Fibrinogen , yu t XIII
Co cc mu ph thuc
_ Tin hnh
+) Dng c : B ly mau TM , 2 ng nghim sch trang nc mui sinh l ( to mi
trng ng trng trn thnh ng nghim HC khng v ), bng m , ng h , ni
370
+) Ha cht : Cn 700 , NaCl 9 %0 trang ng nghim
+) Bnh nhn : Ly mau TM
+) Quy trnh :
B1: anh s , ghi tn ng nghim
B2: Ly mau tnh mch khong >2ml bm vo 2 ng nghim trang mui SL
nt cht bng m cho vo ni cach thy sau 4h em kho sat.
_ Nhn nh kt qu:
+ Co cc mau anh gia 4 mc
L VN CNG
Co hon ton :
Co khng hon ton
Cc mau b nat
Cc mau khng co
15
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Bin lun kt qu: Cc mau khng co , co khng hon ton , cc mau b nat trong
trng hp
+) Gim TC ( SL v /hoc CL ) : Bnh suy nhc TC , KT khng TC , , Leucemia ,..
+) Thiu ht Fibrinogen : Suy gan nng , RL chc nng Fibrinogen
+) Thiu yu t XIII ( xem li chc nng ca yu t XIII )
+) Tng th tch khi HC : a hng cu ( khi HC qu ln ,si Fbrin khng th m ht)
+) iu tr Heparin ( xem gii thch bi APTT )
NG MU
I.
IU HA QU TRNH NG MU
1. Cc yu t hot ha ng mu
Tn yu t
1. Fibrinogen
(I)
2. Prothrombin
(II)
3. Pro-Accelerin
( V)
4. Pro-Convertin
( VII )
5. Yu t VIII
L VN CNG
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Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
( Chng Hemophili A )
6. Yu t IX
( Chng Hemophili B )
7. Yu t X
(Stuart )
8. Yu t XI
( Rosenthal )
9. Yu t XII
( Hageman )
10. Yu t XIII
11. Yu t PK
( Pre-Kallikrein )
12. Yu t H.M.W.K
2. Yu t Tiu cu
_ TC mang cac yu t M xung quanh mnh to nn lp Kh quyn quanh TC
_ TC cha PL mng , khi hot ha tch in m , to iu kin cho yu t M tip xc v gn bam
_ Cht c ch lupus lm kt ta PL tiu cu , ngn IIIIa , gy bin chng huyt khi
3. Yu t t chc (TF)
_ TF c hu ht trong t chc v mch mau, c nhiu trong no v phi , khng c trong TB ni
mch , n to v bc phong ph quanh mch mau nhng li khng tip xc c vi mau do b
ngn cach bi lp ni mch
_ Khi lp ni mch tn thng , TF c gii phng v tip xc vi dng mau , khi ng con
ng ng mau ngoi sinh ( TF gn vi PL TF-phospholipid hot ha yu t VIIVIIa )
4. Yu t Ca2+
_ To iu kin cho yu t ph thuc VTM K ( II , VII , IX , X ) kt hp vi PL hot ha
_ Th hin hot tnh ca yu t XIIIa
_ n nh yu t V , phc h Willebrand-VIIIc
1. Cc yu t c ch ng mu
Nhm 1 : Cc cht c ch Serin protease
1. AT III
_ Sx ti gan , nng trong mau 240 mg/l
( Anti thrombin III )
_ c ch Thrombin , Kallikrein , IXa , Xa , XIa , XIIa
L VN CNG
17
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
2. 1- AT
( Alpha 1 Anti trypsin )
3. 2-MG
( Alpha 2-Macro Globulin )
4. HC II
(Heparin confactor II)
5. Cht c ch C1
L VN CNG
18
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
3. Nhm fibrinogen:
_ Gm cac yu t I,V, VIII, XIII. Cac yu t ny u chu tc ng qua li ca thrombin.
_ c im chung : b tiu th trong qu trnh ng mu nn khng c mt trong huyt
thanh v nhanh b hy (mt hot tnh trong huyt tng lu tr).
_ Yu t VIII cn c c im khng lu hnh n c trong huyt tng, sau khi tng hp
ra ch trong thi gian ngn (8-12 pht) l chng s gn vi yu t von Willebrand nh
m m bo c tnh n nh ca yu t ny.
Tm tt :
1. Yu t ph thuc VTM K khi tng hp , cn Ca2+ khi hot ha : II , VII , IX , X
2. Yu t km bn trong huyt tng lu tr b mt hot tnh : V , VIII , XIII , TC
3. Yu t khng b tiu th trong qua trnh M : II, VII , IX , X
4. Yu t c Heparin gia tc : AT III ,HC II ( tr 1-AT v cht c ch C1 )
IU HA M CA CHT C CH
M
AT III
TFPI
Xa
VIIa
Va+VIIIa
Thrombin
IXa
XIa
XIIa
Kallikrein
Protein C Protein S
HC2
Cht c ch C1
1-AT
2-MG
Tc gi s : L Vn Cng
L VN CNG
19
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
XIa + Ca2+
IX
Thromboplastin+VIIa+Ca2+
Xa
Giai on 1
Giai on 2
Prothrombinase
Prothrombin
(II)
Fibrinogen
V, PL , Ca2+
Thrombin
( Ia )
Fibrin monome
Giai on 3
L VN CNG
20
Khoa xt nghim i hc k thut y t Hi Dng
Tc gi s : L Vn Cng
CM NANG HUYT HC NG MU
1. Con ng ng mu ni sinh
Giai on 1 : Hnh thnh phc h Prothrombinase ni sinh
Yu t tip xc
(XI, XII , PK , H.M.W.K
)
XIIa ( PK ,Kininogen )
XII
XI
XIa + Ca2+
IXa + VIII +Ca2++PL
IX
IX
Xa
V , PL , Ca2+
Tc gi s : L Vn Cng
Prothrombinase
( Va , Xa , Ca2+ , PL
)
L VN CNG
21
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Prothrombin (II)
Thrombin (IIa )
Thrombin
T c ch hot ha Protein C
Tc gi s : L Vn Cng
L VN CNG
22
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Thrombin
VIIa + Ca2+
VII
Xa
V , PL , Ca2+
Tc gi s : L Vn Cng
Prothrombin (II)
Prothrombinase
( Va , Xa , Ca2+ , PL
)
Thrombin (IIa )
23
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
3. Con ng M chung
Thrombin
Fibrinogen
(I)
Fibrin monome
XIIIa
Ca2+
XIII
2. Tc
3. Yu t tham gia
4. XN kho st
M NI SINH
M NGOI SINH
M CHUNG
_ Yu t tip xc
_ Tiu cu
_ Collagen
_ Thromboplastin m
(TF)
Thrombin ngun gc ni
sinh v ngoi sinh
_ Thromboplastin , VII
, X , V , II
IIa , I
_ Thi gian PT
_ nh lng yu t
VII, X, V , II
_ Thi gian TT
_ nh lngFibrinogen
L VN CNG
24
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
25
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
ng 1
L VN CNG
ng 2
26
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
27
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
4. Thi gian APTT (Thi gian Thromboplastin hot ha tng phn , thi
gian Cephalin-Kaolin)
_Nguyn l XN : Mau ton phn c chng ng bng Natricitrat 3,8% em ly
tm ly huyt tng ngho tiu cuthm Kaolin thng nht hot yu t tip xc
thm Cephalin thay yu t 3 phospholipid ca TCthm lng ti u Ca2+. o thi
gian t lc phc hi Ca2+ n khi huyt tng bt u ng ( xut hin mng ng )
_ Mc ch ngha : Thi gian APTT kho sat con ng M ni sinh , giai on
hot ha yu t XXa , khng ph thuc yu t 3- phospholipid ca TC , nn n l
xt nghim ti u nht nh gi M ni sinh
Thi gian APTT ch ph thuc yu t IX , VIII
L VN CNG
28
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Tin hnh :
+) Dng c : b ly mau TM , 2 ng nghim sch loi 75 9,5mm , pipet , ng h ,
ni 370
+) Ha cht : Actin-FS ( np xanh ), dung dch CaCl2 0,025 M
+) Bnh nhn : Anh b bnh l M g cha ? Ung thuc Aspirin khng ? iu tr
Heparin khng ? ( ch hi ko mt im , hoc s b nh hng n kt qu XN )
+) Quy trnh :
B1: Ly mau TMcho vo ng NatriCitrat 3,8% ti vch 2em ly tm
2000vng/10 ly huyt tng ngho TC
B2 : anh s ghi tn ng nghim
B3 : Ht 0,1ml huyt tng vo 2 ng nghim : 0,1ml/ngem 2 ng huyt
tng v ng dd CaCl2 vo ni cach thy.
B4 : Hot ha tng phn
Thm vo mi ng 0,1ml ACTIN FSlc uc 15s/lc u/3
B5 : Phc hi Canci : kho sat tng ng
ng 1 : Thm 0,1ml CaCl2 v bm ng hlc ngang n 9sa ngang tm mt
lc v quan sathuyt tng xut hin mng ngbm ng h dng liT1 ghi kt
qu c phn tch tc.
ng 2: Lm y ht ng 1 huyt tng xut hin mng ngbm ng h dng
liT2 ghi kt qu c phn tch tc. Xem video quy trnh ti a ch
http://www.youtube.com/watch?v=V9dCV1dkZtU
_Nhn nh kt qu
Bnh thng : APTTtb = 30-40s
APTTbnh/chng=0,9-1,15
Ko di > 8s so vi chng
* Ko di : > 1,2
Bnh l >20s so vi chng
_ Bin lun kt qu : APTT ko di trong cc trng hp sau
Thiu yu t VIII , IX , X : bnh Hemphili A , B
C khang ng lu hnh : iu tr heparin , chng ng dng lupus , mnh FDPs,.
Bnh suy gan nng , Bnh Hi chng thn h ,.
Gii thch 1 s trng hp lm thi gian APTT ko di
iu tr Heparin :Heparin l cht chng ng ng tim ,n tc ng ln yu
t thrombin (IIa) ,Xa lm b.i c.trc yu t IIa ,Xa do to phc Xa-AT III-IIaheparin Mt tac dng yu t IIa , Xa. ng thi n gia tc hot ng cho
cac yu t c ch M t nhin khac nh AT III , HC II . c bit l AT III (
tc ng tng gp 2000-3000 ln khi c mt heparin ) .
L VN CNG
29
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
ng 1
L VN CNG
ng 2
30
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
ng 2
PTbnh/chng=0,9-1,15
L VN CNG
31
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Ko di : > 1,15
_ Bin lun kt qu : Thi gian PT ko di trong cc trng hp sau
Thiu ht yu t M ngoi sinh : VII , X , V , II
Thiu VTM K : iu tr ngoi tiu ha , dng khng sinh ko di , thiu bm sinh tr
s sinh,.
Dng thuc chng ng ng ung khang VTM K l dn xut ca Coumarin :
Wafarin ,.
C th c khang ng : iu tr heparin , khng ng dng lupus , FDPs,.
Bnh DIC , Bnh gan , Hi chng thn h ,
_ Lu : Xt nghim thi gian PT ph thuc nhiu vo ha cht thromboplastin ( v
nhiu hang sn xut khc nhau v t nhiu ngun : c th , phi , c ln,.). V vy
WHO a ra ch s INR-ch s bnh thng ha quc t ( International
normalized ratio =INR ) , cho mi xt nghim theo cng thc
= (
)
ISI- ch s nhy cm quc t ( Internation Sensitivity Index =ISI )
Ch s INR c dng theo di bnh nhn s dng thuc chng ng khng VTM K
an ton nn duy tr INR=2-4 . Nu <2 nguy c huyt khi , cn >4 nguy c xut
huyt.
Gii thch mt s trng hp khin thi gian PT ko di :
Thuc chng ng ng ung l dn xut ca Coumarin , n cnh tranh vi VTM K
trong c thc ch hot ng ca cac yu t M ph thuc VTM K nh l : II , VII ,
IX , X , Protein C , Protein S . C ch tac ng nh sau ( theo TS- Nguyn Anh Tr ):
Thuc c tc dng c ch epoxyd reductasec, t lm tng t s oxyd / VTM K.
Lng oxyd nhiu s cnh tranh vi VTM K1 , vng cm thVTM K1 b gim hiu
lc.
iu tr Heparin :Heparin l cht chng ng ng tim ,n tc ng ln yu t
IIa,Xa lm bin i cu trc yu t IIa ,Xa(to phc Xa-AT III-IIa-heparin )Mt tac
dng yu t IIa , Xa. ng thi n gia tc hot ng cho cac yu t c ch M t
nhin khac nh AT III , HC II . c bit l AT III ( tc ng tng gp 2000-3000 ln
khi c mt heparin ) .
L VN CNG
32
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Bnh h thng lupus ban , c khng ng lupus ban : Khang ng Lupus ban
bn cht l cac IgG , IgM . Cac khang th ny lm kt ta PL ca TCc ch s hot
ha ca cac yu t cn PL nh II , X.
Mnh FDPs sn phm ca qu trnh tiu si Fibrin / Fibrinogen : Sn phm thoai ha
Fibrinogen/Fibrin l cac mnh X, Y , E , D ( s cp k phn TSH ).Cac mnh ny c
tac dng c ch ngng tp TC ( nh hng ti CMB v yu t ph thuc
phospholipid TC ). Ngoi ra mnh X, Y c ch s polymer ha ca
FibrinmonomeFibrinpolyme ( mnh E , D tc ng yu hn ). c bit cac mnh E ,
D tng hot ha PlasminogenPlasmin ( tng tiu Fibrinogen/Fibrin ) , thng qua vic
tng hiu lc cac cht hot ha Plasminogen : t-PA , Tcu-PA .,,,,
Bnh gan: Gan l c quan tng hp hu ht cac yu t tham gia qua trnh ng-Cm
mau .Trong bnh suy ganchc nng gan gimKh nng tng hp cac yu t M
gimri lon qua trnh M. Trong bnh vim gan tc mtKh nng to dch mt
gim , cng vi s tc mtDch mt khng/gim xung ta trng nh tng ha
lipid , to iu kin hp thu VTM K tan trong dunh hng n cac yu t ph
thuc VTM K.
Hi chng thn h : Gin mng lc cu thn , cng vi s km tai hp thu cac cht cn
thit ng thn Lm mt nhiu cac yu t M.
L VN CNG
33
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
6. Thi gian TT
_ Nguyn l XN : Mau ton phn c chng ng bng NatriCitrat 3,8% em ly tm
ly huyt tng ngho TCthm 1 lng ti u ha cht Thrombino thi gian t
lc thm ha cht n khi huyt tng bt u ng.
_ Mc ch ngha : Kho sat con ng M chung , anh gia Fibrinogen , giai on
u chuyn FibrinogenFibrin , nh Thrombin
Thrombin
Fibrinogen
(I)
Fibrin monome
_ Tin hnh
+) Dng c : B ly mau TM , 2 ng nghim sch , pipet , ng h , ni cach thy
+) Ha cht : L Thrombin ( 25 v/ml)
+) Bnh nhn : : Anh b bnh l M g cha ? Ung thuc Aspirin khng ? iu tr
Heparin khng ? ( ch hi ko mt im , hoc s b nh hng n kt qu XN )
+) Quy trnh :
B1: Ly mau TM >2mlcho vo l NatriCitrat ti vch 2em ly tm 2000vng/10 ly
huyt tng ngho TC
Xem video quy trnh ti a ch
http://www.youtube.com/watch?v=SgzTJAucbb8
B2: anh s ghi tn ng nghim
B3: Ht 0,1ml huyt tng v 0,1ml NaCl 9o/oo ( n nh pH cho Thrombin v n l 1
enzym, c th thay bng dung dch m) cho vo 2 ng nghim (0,1ml huyt tng+0,1ml
NaCl 9o/oo) / 1 ngem 2 ng huyt tng 370/3
B4: Sau 3 kho sat tng ng
ng 1: Thm 0,1ml ha cht v bm ng hlc ngang n 9sa ngang tm mt
lc v quan sathuyt tng bt u ngbm ng h dng liT1 gi nguyn c
phn tch tc.
ng 2: lm y ht ng 1huyt tng bt u ngbm ng h dng liT2 gi
nguyn c phn tch tc.
L VN CNG
34
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Nhn nh kt qu :
Bnh thng : TTtb=15-20s
Ko di : >5s so vi chng
TTbnh/chng=0,85-1,15
Ko di >1,15
L VN CNG
35
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Tn XN
S lng
2
1.BT (MC)
ngha
Kho sat qua trnh cm mau
ban u , qua anh gia :
yu t thnh mch + tiu cu
v yu t Willebrand ,
Fibrinogen
Mu chy ph thuc
Cht lng thnh mch
S lng tiu cu
Cht lng tiu cu
Thiu yu t
Willebrand+Fibrinogen
Gi tr bnh thng / bt
thng
MC=1-4
+) Bnh thng :
+) Ko di : >6
+) Nghi ng : 4-6 khi phi
tin hnh li vi tai kia hoc
dng pp Ivy
Co cc mu ph thuc
S lng v cht lng ca
TC
S lng v cht lng ca
Fibrinogen
Yu t XIII
Th tch khi HC(hematocrit )
2.Co cc
mu
HT <40%HC>5mm
Cc mau b nat :nhiu HC t
do
Cc mau khng co
khng c cc ng
10
+)Ko di : >15
+) Nghi ng : 10-15 , lm li
bng
APTT , Howell
3.M trn
lam
L VN CNG
36
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
+) Bnh thng :
M = 5-12
+)Ko di >15
+) Nghi ng : 12-15
lm li bng Howell , APTT
Ch : thi gian mu ng < 5
khng c ngha chn on tnh
trng Tng ng (T)
4.M trn
ng
Howelltb = 130-230
Ko di > 60s so vi chng
5.Howell
6.APTT
L VN CNG
Bnh thng :
APTTtb = 30-40s
Ko di > 8s so vi chng
Bnh l >20s so vi chng
APTTbnh/chng=0,9-1,15
Ko di : > 1,2
37
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Bnh thng :
PTtb = 11-14s
Ko di : >2s so vi chng
7.PT
PTbnh/chng=0,9-1,15
Ko di : > 1,15
8.TT
TT ph thuc : nng
Fibrinogen trong mu , cht
lng Thrombin
L VN CNG
Bnh thng :
TTtb=15-20s
Ko di : >5s so vi chng
TTbnh/chng=0,851,15
Ko di >1,15
38
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
TIU SI HUYT
1. Qua trnh M to ra cc mau ng cm mauTuy nhin , nu cc mau ng ny c
tn ti mi trong lng mch s gy nn nguy c tc mch ngn nga u xy ra ,
trong c th c c ch Tiu si huyt lm tan cc mau ng sau khi tn thng
lnh mnh.
2. Tiu si huyt (TSH) c s tham gia ca yu t plasminogen trong mau , n khng gy
tac ng TSH, m cn phi c cac cht hot ha t-PA , Tcu-Pa , chuyn thnh Plasmin ,
gy ra tac ng tan cc mau cha si Fibrin/ Fibrinogen.
3.Tuy nhin , nu hot ng TSH lan trn c th dn ti bin chng chy mau , do , cn
c cac yu t c ch qua trnh TSH. Cac cht c ch TSH y gm 2 nhm
Nhm 1l : c ch s hot ha PlasminogenPlasmin , thng qua bt hot yu t hot
ha Plasminogen l t-PA , Tcu-PA
Nhm 2 gm : Cac cht khang PlasminLm mt tac dng tiu cc mau ca Plasmin
_ Sn phm ca qua trnh TSH , li tham gia iu ha M mc khac nhau. ( s trnh
by r phn sn phm TSH )
L VN CNG
39
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
I.
A - Plasminogen v Plasmin
TN
C IM
VAI TR
gm 791aa
_ Sn xut ti gan , c mt trong huyt
tng , TB BC on trung tnh , mng TC
,b mt TB ni mc, dch bao khp.
_ Nng trong mau : 0,13-0.2 g/l
1.Plasminogen
_ Plasminogen tng trong 1 s bnh :
Nhim trng , phn ng vim , thai nghn
Gim trong bnh gan , iu tr chng
ng ,.
_ Plasminogen khng bn vng vi nhit
v pH trung tnh , b mt hot tnh 560C
ng ca Plasmin.
_ V vy , nu cha c s
xut hin ca Fibrin th tac
ng tiu si huyt cha
xy ra.
2.Plasmin
trong c th c cc mau
ng , vi s c mt ca si
Fibrin. Ch bnh thng
trong c th khng c
plasmin.
plasminogen , nn v cu to , trnh t sp
xp aa , tnh KN ging plasminogen
_ Plasmin c ph tac dng
_ Plasmin hot ng pH trung tnh
rng , n khng ch phn
hy Fibrin/Fibrinogen , m
cn phn hy c yu t :
v-WF , V , VIII , XIIIa ,......
L VN CNG
40
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
C IM
VAI TR
_t-PA ch hot ha PlasminogenPlasmin
1.
mc , 1 t c sx t TB cnh
biu m , Mu TC , BC mono,...
.
_ t-PA hot ha Plasminogen
cc i pH kim
t-PA
_ Urokiase c sn xut bi TB
2. Tcu-PA
(Urokiase)
L VN CNG
41
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Fibrin
(ccng)
TB thn
Pro-Urokiase (Scu-PA)
t-PA
Urokiase ( Tcu-PA)
Plasminogen
Plasmin
L VN CNG
42
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
1.2-Antiplasmin (2-AP )
_ 2-AP c tng hp t gan , c ch trc tip
PAI-1 : c ch t-PA v tcu-PA
plasmin , v c ch c cht hot ha plasminogen
,bng cch to phc bt hot , c
(t-PA , tcu-PA )nhng chm
kh hic ch hot ha
_ 2-AP gn c nh vo v tr hot ng ca
plasminogen
plasmin v c ch v tr hot ng , lin kt ny
_Nng trong huyt tng :
lc u c th hi c , nhng v sau th khng
1-100ng/ml
hi phc
_ PAI-1 tng trong PNCT , ngi bo
_Ngoi ra, nh tac ng ca yu t XIIIa , 2-AP
ph , T , vim-nhim khun
lin kt trc tip vi chui Fibrin , t hn ch s
c nh Plasminogen vo Fibrin
2.Antithrombin III ( AT III)
PAI-2 : c ch t-PA hot ha ,
_AT III l cht c ph tac dng rng , ngoi c ch
c bit l Tcu-PA
hot ng yu t M , n cn l cht khang
_ PAI-2 : tng ch yu khi c thai ,
plasmin. Bng cach to phc vi plasminmt tac
LXM th M4 , M5, khi u,..
dng ca plasmin
3. 1-Antitrypsin (1-AT)
_ Nh ni phn II5 , Trypsin cng l cht c kh nng hot ha plasminogen.
_ 1-Antitrypsin cng ging AT III l cht c ph tac dng rng ngoi c ch hot ng
yu t M , n cn l cht khang plasmin lm mt tac dng ca Trypsin bng cach ct i
1 lin kt peptid
4. Cht c ch C1
_ Quay tr li vi phn II2 , Pro-UrokiaseUrokiase , nh s tc ng ca Plasmin, Kallikrein ,
XIIa.
_ Nh vy , cht c ch C1 c ch TSH bng cach ngn khng cho
43
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
TB ni mch
Fibrin
(ccng)
TB thn
Pro-Urokiase (Scu-PA)
t-PA
Urokiase ( Tcu-PA)
Plasminogen
Plasmin
Sn phm thoai
ha FDPs
1.2-Antiplasmin (2-AP )
2.Antithrombin III ( AT III)
3.1-Antitrypsin (1-AT)
4.Cht c ch C1
5. 2-Macroglobulin (2-MG)
PAI-1
PAI-2
Tc gi s : L Vn Cng ci bin
L VN CNG
44
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
NHC LI S NG MU
Yu t tip xc
(XI , XII , PK , H.M.W.K )
XII
XIa + Ca2+
IX
Thromboplastin+VIIa+Ca2+
Xa
Giai on 1
Giai on 2
Prothrombinase
Prothrombin
(II)
Fibrinogen
V, PL , Ca2+
Thrombin
( Ia )
Fibrin monome
Giai on 3
L VN CNG
45
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
NHC LI IU HA M CA CHT
C CH M
AT III
TFPI
Xa
VIIa
Va+VIIIa
Thrombin
IXa
XIa
XIIa
Kallikrein
Protein C Protein S
HC2
Cht c ch C1
1-AT
2-MG
Tc gi s : L Vn Cng
L VN CNG
46
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
47
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Tin hnh :
+) Dng c : ng nghim , pipet , ng h , ni cach thy
+) Ha cht :A.acetic 2% ,
m Michaelis pH=7,35 ( empha long t l 1:4 vi NaCl 0,9%)
NaCl 0,9%
CaCl2 0,1M
+) Bnh nhn : Khng c dng thuc chng ng . Hi (Anh b bnh l M
g cha ? Ung thuc Aspirin khng ? iu tr Heparin khng ? ( ch hi ko
mt im , hoc s b nh hng n kt qu XN )
+)Quy trnh :
B1: Ly >2ml mau TMcho vo l Natricitrat 3,8% ti vch 2em ly tm
1500vng/10 ly huyt tng giu tiu cu.
B2: anh s , ghi tn ng nghim
B3: Ht 0,3ml huyt tng thm 3ml nc ctthm 1 git A.acetic 2% ,
kim tra c pH=5,2
B4: em ly tm 3000vng/15gn b phn trong (yu t c ch TSH) + gi li
phn trong ( yu t hot ha TSH)Dng giy thm, thm kh thnh ng (
loi b hon ton phn yu t c ch c th bm vo ng )
B5: Thm 0,3ml m Michaelis pH=7,35 ( pha )Dng que anh tan
tathm 1git CaCl2 0,1Mem vo ni 370C ch ngGhi thi im
ng v theo di thi gian tan hon ton , bng cch 15 nhc ng xem 1 ln.
_ Nhn nh kt qu : Thi gian tan tiu euglobulin bnh thng >60
<15 TSH cp
15-30TSH nng
30-45TSH va
45-60TSH nh
_ Bin lun kt qu : Khi cc ng euglobulin khng hnh thnh
Do k thut :
Thm A.acetic khng : pH khong 5,2 th vic to ta fibrinogen l tt nht. Nu
pH ln s khng to ta hoc ta rt t, ngc li nu pH nh hn 5,2 s ta c cac
cht c ch tiu si huyt hoc thm ch pha hng c cu trc cac cht (v pH thp qua
m)
Thm ng nghim khng kh ( yu t c ch vn bm vo thnh ngc ch yu t
hot ha TSH thi gian tan ko di gi to do gim hnh thnh plasmin.
Do bnh l :
H thng hot ha Plasminogen qua mnhng n u tan n y
L VN CNG
48
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
3000vng/15
1 git A.acetic 2%
m
Michaelis
pH=7,35
300ml
1 git Ca2+
L VN CNG
49
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
50
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Dng c ha cht :
B kit xt nghim D-dmimer gm :
+) Latex Reagent : hn dch latex gn KT , KN D-dimer
+) D-dimer hiu chun
+) Dung dch m pha long
+) Chng m , chng dng
+) Tm card thc hin phn ngBan nh lng bng tay
Tin hnh
_ Ly mau TM chng ng Natricitrat 3.8% ly tm 2500 vng/15 ly huyt
tng ngho TC
_ Ban nh lng ( lm bng tay )
+) Trong vng trn trn tm card lm xt nghim , thm 20l huyt tng cn kim
tra ( khng pha long )
+) Trong vng trn khac trn card , thm 20 l chng dng
+) Trong vng trn khac trn card , thm 20 l chng m
+) Thm vo mi vng trn 20 l Latex Reagent nghing v trn trong 3
+) Kim tra ngng kt , so sanh vi chng dng v chng m anh gia kt qu.
+) Trng hp dng tnh , ban nh lng bng cach pha long huyt tng cn
kim tra theo t l 1/2, 1/ 4, 1/8, 1/6
L VN CNG
51
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Mu kim tra
nguyn Pha 1/2
(-)
(+)
(-)
(+)
(+)
(+)
(+)
(+)
(+)
(+)
(+)
Pha 1/4
(-)
(-)
(+)
(+)
(+)
Pha 1/8
(-)
(-)
(-)
(+)
(+)
Pha 1/6
(-)
(-)
(-)
(-)
(+)
Nng g/ml
<0.05
0.5
1
2
4
8
<1
<2
<4
<8
Bin lun kt qu :
_ D-dimer tng trong : tng tiu Fibrin , DIC , tiu si huyt tin phat , huyt khi , ph
n c thai , do can thip hoc chn thng D-Dimer cng tng
_ D-dimer bnh thng loi tr c nghi ng tc mch do huyt khi.
L VN CNG
52
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
53
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
23,9 ml
- Na2HPO4 0,15 M
76 ml
- NaCl 0,85 %
100 ml
0,25 M
0,1 M
L VN CNG
54
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
55
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
= 0,5g/ml.
6000
L VN CNG
56
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
57
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Ch s Rosner:
(+) ( )
( )
_ Nhn nh kt qu:
6.1
Nguyn l
Thi gian mt xt nghim ng mau ngoi sinh ko di do: hoc thiu ht mt hay nhiu
yu t ng mau hoc s c mt ca cht khang ng lu hnh.
Nguyn l phat hin khang ng lu hnh ngoi sinh da vo kh nng b ca cac yu t
ng mau. Thi gian ng ca hn hp 1 th tch huyt tng bnh thng v 1 th tch
huyt tng ca bnh nhn thiu ht 1 hay nhiu yu t ng mau s gn bng thi gian
ng ca huyt tng bnh thng. Trai li, thi gian ng ca hn hp 1 th tch huyt
tng bnh thng v 1 th tch huyt tng ca bnh nhn c cht khang ng lu hnh s
ko di gn bng thi gian ng ca huyt tng bnh nhn.
Dng c:
- ng nghim, pipet, ni cach thy, may ly tm
L VN CNG
58
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Ha cht:
- Natri citrat 3,8%
- Thromboplastin
- CaCl2 M/40
- Huyt tng chng
Bnh nhn:
- Khng s dng cac thuc chng ng.
Tin hnh
- Ly mau, chng ng bng natricitrat 3,8% theo t l 1/10
- Ly tm tach huyt tng ngho tiu cu
- Pha hn hp huyt tng chng v huyt tng bnh theo t l 1:1
- Chun b 3 ng nghim, anh s 1,2,3
- ng 1 cho 0,1 ml hn hp huyt tng bnh nhn v huyt tng chng
- ng 2 cho 0,1 ml huyt tng chng
- ng 3 cho 0,1 ml huyt tng bnh nhn
- Pha hn hp thromboplastin : CaCl2 M/40 theo t l 1:1.
- Thm 0,2 ml hn hp thromboplastin calci vo ng 1, bm ng h. Lc ti 9s, quan sat
mng ng v ghi kt qu.
- Kho sat ng 2 v 3 tng t. Ghi kt qu.
Kt qu:
Khi thy kt qu thi gian ng ca mu huyt tng hn hp chng v bnh gn vi thi
gian ng ca huyt tng bnh chng t s c mt ca cac cht khang ng lu hnh.
(+) ( )
Ch s Rosner:
( )
anh gia kt qu:
< 12: khang ng ngoi sinh (-)
12 15: khang ng ngoi sinh nghi ng.
> 15: Khang ng ngoi sinh (+)
- C cac cht khang ng cac yu t: II, V, VII, X
Cc cht khng ng ngoi sinh bao gm:
+ Antithrombin III (AT III): Xa, Thrombin...
+ 1 Antitypsin: thrombin
+ 2 Macroglobulin: thrombin
+ Protein C, Protein S: thoai ha yu t V -> gian tip kim soat Xa v thrombin
L VN CNG
59
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
+ Nexin protease 1
+ TFPI (tissue factor pathway inhibitor Cht c ch con ng yu t t chc)
+ Cht c ch trong bnh Lupus ban : gy ta phospholipid-> ng hng s chuyn
prothrombin(II) thnh thrombin(IIa). ng thi cnh tranh gy nh hng ti s hot ng
ca yu t X.
Cc yu t nh hng kt qu xt nghim:
- Cht lng thromboplastin
- Huyt tng chng tp hp ca t hn 10 ngi.
- Huyt tng qua 4 gi.
6.2
_ Nguyn l
Thi gian mt xt nghim ng mu ko di do: hoc thiu ht mt hay nhiu yu t
ng mu hoc s c mt ca cht khng ng l-u hnh. Nguyn l pht hin khng
ng l-u hnh da vo kh nng b ca cc yu t ng mu. Thi gian ng ca hn
hp 1 th tch huyt t-ng bnh th-ng v 1 th tch huyt t-ng ca bnh nhn thiu ht
1 hay nhiu yu t ng mu s gn bng thi gian ng ca huyt t-ng bnh th-ng.
Tri li, thi gian ng ca hn hp 1 th tch huyt t-ng bnh th-ng v 1 th tch
huyt t-ng ca bnh nhn c cht khng ng l-u hnh s ko di gn bng thi gian
ng ca huyt tng bnh nhn.
_ Dng c, thuc th, ho cht
- Bnh cch thu 37oC.
- ng nghim 75x9,5mm.
- ng h bm giy.
- Huyt t-ng chng.
- Tu theo loi xt nghim cn tin hnh (thi gian prothrombin hay thi gian kaolincephalin hot ho v.v) m chun b thuc th.
_ Tin hnh k thut
- Ly mu tch huyt t-ng: nh- xt nghim thi gian Howell
- Tin hnh xt nghim ng thi vi 3 mu huyt t-ng trong cng iu kin:
+ Mu huyt t-ng chng.
+ Mu huyt t-ng bnh.
+ Mu huyt t-ng hn hp chng v bnh theo t l 1/1.
- Ghi thi gian ng ca c 3 mu.
Trong mt s tr-ng hp, tin hnh li xt nghim vi c 3 mu sau khi 2 gi bnh cch
thu 37oC.
_ Kt qu
Thi gian ng ca mu huyt t-ng hn hp chng v bnh t l 1/1 ko di gn vi thi
gian ng ca huyt t-ng bnh chng t s c mt ca khng ng l-u hnh. Cn tin hnh
xc nh bn cht ca khng ng l-u hnh ny.
L VN CNG
60
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Thi gian
Cephalin
Kaolin
Ko di
Bnh th-ng
Ko di
Ko di
Thi gian
Prothrombin
Bnh th-ng
Ko di
Ko di
Ko di
Thi gian
Thrombin
Bnh th-ng
Bnh th-ng
Bnh th-ng
Ko di
L VN CNG
61
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
- S khc nhau gia thi gian ng ca ng huyt t-ng giu v ngho tiu cu ni ln hot
tnh yu t 3 tiu cu.
- Qua thi gian ng ca cc ng huyt t-ng chng ta v -ng thng chun trn giy bn
Logarit vi trc tung l thi gian ng, trc honh l cc nng tiu cu (50 109/l t-ng
-ng 100%, 25 109 /l t-ng -ng 50%...).T th ny tnh -c hot tnh yu t 3 tiu
cu ca bnh nhn qua thi gian ng.
Nguyn nhn sai lm
- Mu ly lu qu 3 gi mi lm xt nghim.
- Pha long tiu cu khng chnh xc.
8. nh lng yu t XIII
Nguyn l
Yu t XIII -c hot ho trong qu trnh ng mu nh Ion calci v thrombin. Yu t
XIII hot ho lm n nh cc fibrin.
Khi c yu t XIII cc fibrin s khng ho tan trong dung dch ure 5 mol/l, cn cc
fibrin -c to t huyt t-ng thiu yu t XIII s b tan.
Thuc th, ho cht
- Huyt t-ng Citrat ca bnh v ca chng.
- CaCl2 M/40
- Ure 5 mol/l (300 g/l)
Tin hnh k thut
- Chun b 2 ng nghim thu tinh 75 x12 mm
- Cho 0,2 ml huyt t-ng chng hoc bnh vo mi ng
- Cho thm 0,2 ml CaCl2 M/40 vo tng ng
- thng cch thu 370C trong 30 pht, sau thm 3 ml dung dch ur 5 mol/l.
- Lc cc ng trong dung dch ur. ng nghim nhit phng qua m v kim tra
cc ng vo hm sau.
Kt qu
- Nu yu t XIII c trong huyt t-ng th cc ng vn cn.
- Ph-ng php ny th-ng ch dng chn on thiu yu t XIII bm sinh v nhng
tr-ng hp yu t XIII < 1%
- L-u :
- bit kh nng lm tan cc fibrrin ca dung dch ur, ng-i ta tin hnh lm xt nghim
L VN CNG
62
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
vi ng chng d-ng nh- sau: trong ng nghim cho 0,2 ml huyt t-ng citrat, 0,2ml
thrombin, sau cho dung dch ure nh- trn. Cc ng s tan trong ure v yu t XIII khng
hot ho do thiu Ca++.
- C th thay dung dch ur 5 mol /l bng acid monochloracetic 2%.
L VN CNG
63
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
64
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
65
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
+ 0,1 ml thromboplastin
- vo bnh cch thu 30 giy,
- Sau thm vo mi ng 0,1 ml CaCl2, bm ng h theo di thi gian ng.
- K -ng biu din gia thi gian ng vi pha long trn giy logarit kp.
- Tip tc lm nh- th vi huyt t-ng bnh ri c kt qu trn th.
Ghi ch: c th chun b cc huyt t-ng thiu cc yu t nh- sau:
- Huyt t-ng khng c yu t V c th -c chun b bng cch ly huyt t-ng oxalat
370C trong 3 ngy trong iu kin v trng (mu chng ng t l 9:1 vi oxalat natri 14
g/l), bo qun -20 0C.
- Huyt t-ng khng c yu t VII c th chun b t huyt t-ng bnh nhn dng Warfarin
sau 48 gi hoc huyt t-ng ca mt loi ch c thiu ht yu t VII bm sinh.
- Nc rn Viper i Loan (oxyuranus scutellatus) c kh nng trc tip bin prothrombin
thnh thrombin trong s vng mt ca nhng yu t ng mu bit no . V th c th
dng n nh- mt thuc th c hiu nh l-ng yu t II mt th.
- Bch Quc Tuyn v cng s sn xut thuc th nh l-ng yu t II t huyt thanh
oxalat ho v huyt t-ng ht vi t l 1:2
- Thuc th nh l-ng yu t VII -c sn xut t huyt t-ng cu chng ng bng
wintrobe, ht bng bt silicagen G hoc trn mng lc aming 20 %.
L VN CNG
66
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
11.nh l-ng yu t X
Nguyn l
- Thay th thromboplastin trong thi gian Quick bng nc rn h mang Russell pha long
ta s c thi gian ng di hn. Nc rn hot ho rt mnh yu t X m khng cn s tham
gia ca yu t VII.
- nh l-ng yu t X, ng-i ta dng mt thuc th l huyt t-ng b lc qua than
hot. Thuc th ny thiu ht c hai yu t VII & X. Nh-ng nu thay thromboplastin bng
nc rn Russell xt ghim thi gian prothrombin, yu t VII thiu ht s khng nh
h-ng n kt qu.
- So snh thi gian prothrombin vi nc rn Russell ca thuc th nh yu t X ca huyt
t-ng chng v bnh bit nng yu t X ca bnh nhn.
Thuc th, ho cht
- Huyt t-ng b lc amiang ( khng c yu t X )
- Dung dch nc rn Russell 1/150000 pha vi Cephalin.
- Cephalin pha vi m mui pH 7,4 c nng thch hp.
- Huyt t-ng Citrat ca chng v bnh.
- CaCl2 m//40.
- ng nghim, pipet, thng cch thu, ng h bm giy.
Tin hnh k thut
- Pha long huyt t-ng chng v bnh 1/10, 1/100, 1/1000 trong m mui pH 7,4.
- Cho vo mi ng nghim 0,1 ml huyt t-ng b khng c yu t X, 0,1 ml huyt t-ng
chng v bnh pha long cc nng v 0,1 ml thuc th gm nc rn vi cephalin.
- vo thng cch thu.
- Sau ng 30 giy cho thm 0,1 ml CaCl2 M/40, bm ng h theo di thi gian ng.
Lm mi ng ca mi nng lp li 2 ln.
Kt qu
- Thi gian ng ca cc nng huyt t-ng chng s -c v thnh -ng thng trn
giy logarit kp.
- Hot tnh yu t X ca bnh c th c trn th theo kt qu thi gian ng ca ng
c huyt t-ng bnh pha long 1/10.
Nguyn nhn sai lm
L VN CNG
67
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
68
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Bn nh l-ng
Nguyn l
Cc nng pha long ca huyt t-ng bnh th-ng v mu xt nghim -c lm ng
bng thrombin. So snh hin t-ng ng nhng nng pha long khc nhau tnh t l
fibrinogen trong mu xt nghim.
Cc xt nghim -c thc hin vi dung dch pha long: (a) trong n-c mui, (b) trong
n-c mui c cha Epsilon aminocaproic acid (EACA) ngn nga tiu si huyt v (c)
trong n-c mui c cha protamin sulphat ngn nga tc dng c ch ca sn phm thoi
ho fibrinogen v fibrin nu c. Trong nhng tr-ng hp cp cu ch nhng nng pha
long vi n-c mui c th cho nhng thng tin cn thit.
Thuc th, ho cht
- Huyt t-ng citrat ca bnh nhn v ng-i bnh th-ng.
- Thrombin: pha 50 n v NIH trong 2 ml dung dch NaCl 9 0/00 ngay tr-c khi
dng.
- EACA: 1 mg/ ml dung dch NaCl 9 0/00
Tin hnh k thut
- Chun b 3 b, mi b 7 ng nghim xt nghim huyt t-ng bnh th-ng v 3
b khc t-ng t xt nghim huyt t-ng bnh nhn.
- Mi ng ca b th nht cho 0,5 ml n-c mui.
- Mi ng ca b th hai cho 0,5 ml EACA pha trong n-c mui.
- Trong ng mt ca b th ba cho 0,5 ml protamin sulphat pha trong n-c mui v
6 ng cn li cho 0,5 ml n-c mui.
- Thm 0,5 ml huyt t-ng bnh th-ng hoc mu xt nghim vo ng u ca mi
b, trn u v chuyn 0,5 ml sang ng 2 v tip tc t-ng t sang ng 3, 4...nh- vy ta
s c nng huyt t-ng t 1/2 n 1/128.
- Thm 0,1 ml thrombin vo mi ng v trn u.
- t cc ng vo bnh cch thu 370C v yn 15 pht, sau kim tra xem c
fibrin hay khng (c ng hay khng) ?
L VN CNG
69
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
Kt qu
- Bnh th-ng fibrin s c trong tt c cc nng pha long huyt t-ng t 1 n
1/128. Trong gim fibrinogen nng th khng thy cc ng bt k nng no, nu
gim nh th s c cc ng fibrin 1 - 3 ng u.
- Nu thy cc ng cc ng c EACA pha long hn so vi ng ch c n-c mui
th chng t tiu si huyt nng.
- Nu thy cc ng ng c protamin sulphat nng pha long cao hn so vi
ng ch c n-c mui l c sn phm thoi ho fibrinogen v fibrin trong huyt t-ng.
- Cc ng nghim ca b huyt t-ng bnh th-ng dng lm chng d-ng.
L VN CNG
70
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
71
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
BNH NG MU
I.
1. nh ngha
_ DIC l bnh l ng mau tiu th , c trng bi s hot ha qua mc cac yu t
Mto ra nhiu cc huyt khi nh ri rac lng mch . S tng hot ng qua trnh
M tng hot ha qua trnh tiu cc mau ng. C 2 qua trnh dn n tiu th qua mc
cac yu t M v TC. Hu qu ri lon ng mau gm chy mu v huyt khi.
C ch
1. Nhim khun
_ VK tit ra ni c t:
Khi ng M ni sinh : hot ha trc tip yu t XII v gian
tip yu t XII , qua hot ha yu t tip xc PK.
Khi ng M ngoi sinh : bc l yu t TF trn mng TB
monocyte v TB ni mc.
c ch qt TSH: c ch TB ni mc gim sn xut yu t hot
ha plasminogen t-PA , ng thi tng gii phng yu t c
ch plasminogen PAI-1 , PAI-2
2. Bnh l sn khoa
_ Rau bong non ,thai
lu
_ Tc mch nc i
L VN CNG
72
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
73
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
2. nh lng FDPs
(Nghim php ethanol )
_ Bnh thng : <10 g/ml hoc (-)
3. nh lng D-dimer
_ Bnh thng < 200mg/l hoc (-)
L VN CNG
74
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
II.
1. nh ngha
_ TTP l bnh xut huyt gim tiu cu min dch , thng gp ph n tr , bnh c
trng bi tnh trng xut huyt do gim nng s lng tiu cu (<50G/L)tn thng
TB ni m thnh mchthc y qua trnh ng-cm mauHu qu l bnh nhn c
c HC xut huyt v HC huyt khi th pht.
2. C ch bnh sinh
_ Do tnh trng nhim trng , hoc iu tr ha cht a vo c th , y l cac cht l
i vi c th (KN) , kch thch c th sinh KT tng ng .
Trong huyt thanh bnh nhn c KT chng li TC , KT ny bam ln b mt mng tiu
cu , lm bin i cu trc mng tiu cu. Khi tiu cu i qua h lin vng ni m s b
bt gi v thc bo , hoc b tiu hy khi c mt b th.
_
_ m s lng TC : <50G/L
_ Nghim phap dy tht (++++)
_Thi gian mau chy : ko di >6
_ XN co cc mau : cc mu khng co/co khng hon ton
2.ng mau
1.XN tm KT chng li TC
2.Nghim phap Coombs tiu cu
3.o i sng TC (8-12 ngy ): rt ngn ch cn vi gi
C. TY
1. S lng MTC : tng
L VN CNG
75
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
2.ng mau
L VN CNG
CM NANG HUYT HC NG MU
B. CC XT NGHIM HA SINH
Tn XN
Thay i trong HUS
Gii thch kt qu
1.LDH
LDH tng > 480U/L _ LDH c mt trong bo tng ca mi TB.
(200-480U/L)
HUS do tan HC nn gii phng ra nhiu LDH
2.Ure mau
Ure tng cao > 7,5
_ Ure tng t l vi mc tan huyt ( xem c
(2,5-7,5mmol/l) mmol/l
ch phn trn)
3.Creatinin mau Creatinin tng cao
_ Creatinin c to ra c, ch yu t
60-120mol/l
creatinphosphat v creatin c. Creatinin theo
53-110mol/l
mau qua thn, c thn lc v bi tit ra nc
tiu.
_ Suy thn lm gim o thi Creatinin dn ti tng
cao trong mau. y l ch s vng nh gi tnh
trng suy thn
L VN CNG
77
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
2. 1- AT
2-MG
( Alpha 2-MacroGlobulin )
4. HC II
2. Protein S (PS)
3. Thrombomodulin
L VN CNG
78
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
C IM
VAI TR
_t-PA ch hot ha
_ t-PA sn xut ch yu TB
1. t-PA
ni mc , 1 t c sx t TB
cnh biu m , Mu TC , BC
mono,...
2. Tcu-PA
(Urokiase)
_ Pro-UrokiaseUrokiase ,
nh s tac ng ca Plasmin
Kallikrein , XIIa
L VN CNG
79
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
A. Cht c ch hot ha
Plasminogen
B.
1.2-Antiplasmin (2-AP )
1-Antitrypsin (1-AT)
4.
Cht c ch C1
L VN CNG
80
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
2. Nguyn nhn
T tin pht ( di truyn)
T th pht ( mc phi )
1. C ch
2. Lm sng
L VN CNG
81
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
3.Cu trc HK
4.XN chn
on HK
1.CMB-M
1.CMB-M
_ S lng TC tng
_ S lng TC tng
_APTT , PT , TT rt ngn
_APTT , PT , TT rt ngn
2.nh lng yu t M
2.nh lng yu t M
_ Fibrinogen tng
3.TSH
_ nh lng D-dimer :
_ nh lng D-dimer :
tr nguyn nhn tc
mch do HK
loi
D-dimer tng/(+)
D-dimer tng/(+)
loi
L VN CNG
HK
82
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
NG MU THAI NGHN
I. THI K C THAI
_ Gim s lng tiu cu < 150G/L do b pha long
_ Tng yu t hot ha M ( VIII , yu t Willebrand, VII, X , Fibrinogen )
_ Gim yu t c ch M : AT III gim nh , PC tng nh , c bit PS gim nhiu.
_ Gim kh nng TSH
S tng yu t hot ha yu t M gim yu t c ch M-Gim kh nng
tiu si huyt Tnh trng tng ng
II. THI K HU SN
_ S lng TC tr v bnh thng sau 24h
_ Tt c cac yu t M tr v bnh thng sau 3-6 tun
L VN CNG
83
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
BNH HEMOPHILIE
1. nh ngha
_ Hemophilie l bnh di truyn do gen ln nm trn nhim sc th gii tnh X , bnh ch
biu hin nam gii mang gen bnh hoc n gii th ng hp ( trng hp ny kh sng
ti tui trng thnh )
_ Bnh xy ra do thiu ht yu t VIII ( Hemophilie A ) , thiu ht yu t IX (Hemophilie
B) , thiu ht yu t XI (hemophilie C). Trong hay gp nht Hemophilie A chim 85%,
Hemophilie B chim 15% . Hemophilie C him gp, tnh trng nh , bnh gp c nam v
n, do n di truyn gen tri nm trn NST thng.
_ Bnh biu hin c trng bi tnh trng xut huyt , t mau c-khp ( ni chu p lc
ln ) , tai phat nhiu ln gy bin chng teo c , cng khp , dn n tn ph sut i.
2. Di truyn ph h
B bnh thng M gen bnh 50% gen bnh : 50% bnh
XY XaX XaX : XX : XaY : XY
B bnh M bnh thng 100% gen bnh : 100% bnh thng
XaY XX XaX : XaX : XY : XY
B bnh M gen bnh 50% bnh : 50% gen bnh
50% bnh : 50% bnh thng
XaY XaX XaXa , XaX , XaY , XY
84
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
85
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
RI LON NG MU MC PHI
_ Thiu vitamin K
_ Bnh gan
_ Bnh lupus ban
_ Ri lon ng mau sau truyn mau lu tr t
_ Vim thnh mch d ng
I. THIU VTM K
1. Nguyn nhn C ch bnh sinh
_ C ch bnh sinh : VTM K cn thit cho s tng hp yu t II , VII , IX , X , PC ,
PSThiu VTM K dn n cac yu trn c tng hp ra nhng khng c kh nng
hot ha.
_ Nguyn nhn :
+) Gim hp thu ( vim gan tc mt , tc rut , suy gan ) : Dch mt c gan to ra ,
xung ta trng trong qua trnh tiu ha. Dch mt c vai tr nh tng ha lipid , to
iu kin hp thu cac VTM tan trong du , trong c VTM K Vim gan tc mt lm
bi tit mt xung ta trnggim hp thu mgim hp thu VTM KRLM
+) Gim tng hp ( iu tr khang sinh ko di ) : Mt s VK ng rut c kh nng
tng hp VTM K cho c th dung KS ko ditiu dit h VK nygim tng hp
VTM K cho c thRLM.
+) Bm sinh tr s sinh : Do kh nng to mt ca gan cha y , h VK ng
rut cha phong ph tim b sung VTM K cho tr.
Gim yu t II , VII , IX , X
Thi gian PT ko di
Thi gian APTT bnh thng/ hoc ko di ( gim nng yu t X )
Thi gian TT bnh thng
SLTC bnh thng , BT bnh thng
L VN CNG
86
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
87
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
88
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
89
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
90
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
BIN LUN XN NG MU
Bnh l c th
Cc xt nghim vng 2
APTT PTT TT TC
1
_ Truyn mu d tr t (Mau d tr mt
nhiu yu t TC , VIII , XIII.Fibrinogen
bnh thng.)
_ Suy gim chc nng gan
_ Bnh DIC
_ Bnh gan cp km DIC
L VN CNG
_ nh lng yu t VIII , IX , XI
, XII
_ nh lng yu t VIII
_ Tm cht khang ng lupus
_ Xn anh gia chc nng gan
_ nh lng yu t VII , X , V ,
II
_ Kim tra iu tr : ngoi tiu
ha , iu tr KS
_ Dng s dng thuc chng
ng , ri kim tra li
_ Tm cht khang ng
_Xn anh gia chc nng gan
_ nh lng yu t X , V , II
_ Kim tra li iu tr : ngoi tiu
ha , thuc KS
_ Dng s dng thuc chng
ng, kim tra li
_Xn anh gia chc nng gan
_ Ngng s dng heparin , kim
tra li.
_ nh lng yu t Fibrinogen
_ nh lng FDPs
_ XN chc nng gan
_ Tm nguyn nhn gim TC :
+) Ty
+) Tm KT khang TC
_ Truyn mau ti nu > 10v
_ XN anh gia chc nng gan
_ Nghim phap Von-Kaulla
_Nghim phap Ethanol
_ nh lng FDPs
91
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
CC GI TR AN TON V NG MU CHO
CUC M AN TON
1.
2.
3.
4.
5.
6.
L VN CNG
92
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
TM HIU MT S THUC-CHT
CHNG NG V C CH TC DNG
TRONG XN V IU TR
I. Heparin
_ Heparin tc ng ln ch yu ln con ng M ni sinh : tc ng ln yu t thrombin
(IIa) ,Xa lm b.i c.trc yu t IIa ,Xa to phc Xa-AT III-IIa-heparin Mt tac dng
yu t IIa , Xa.
_ Phc hp sinh ra giac Heparin-AT III cn gia tc hot ng cho cc yu t c ch M
t nhin v tng phn hy thrombin ( Tc ngca AT III tng gp 2000-3000 ln khi c
mt heparin ) .
_ Heparin c th gn n mc bo ha vi cac protein huyt tng , TB ni mc ,
Monocyte.
_ Thi gian ban hy ca Heparin l 30-150 pht
II. Natricitrat
_ Natricitrat to phc c hi phc vi Ca2+ , lm gim Ca2+ trong mau , Ca2+ l yu t cn
thit cho s hot ha ca yu t : VII , X , V , II cac yu t ny khng c hot
haM b c ch.
L VN CNG
93
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_ Trong truyn mu : Mau d tr truyn cho bnh nhn thng s dng Natricitrat t l
3-4 gam/0.5ml mau . Khi vo c th nng b pha long nn khng gy chy mau ,
nhng c th gy c natricitrat nu truyn mau d tr nhiu ln.
_ Trong xt nghim : Natricitrat ph hp cho cac XN huyt hc M , v n ch c ch tm
thi qua trnh ng mau , khi phc hi Ca2+ , qua trnh li din ra bnh thng .
+) Ch : T l chng ng y l 1mu : 9 chng ng , nu dng sai t l XN s b
nh hng do :
Nu ly lng mau nhiu hn quy nh th s lm mau b ng (c th ch l ng
dy) v nh vy kt qu XN tt nhin s sai (rt ngn thi gian ng).
Nu ly mau t hn th s lm d lng Natri. V vy khi lm XN (phc hi li
Canxi) th lng Natri d s c ch 1 phn lng Canxi cho vo (m lng Canxi cho vo
l c nh) do vy s lm gim nng Canxi t lm thay i thi gian ng (thng l
ko di hn). Nh vy kt qu s khng chnh xac.
* V vy vi Xn ng mu phi ly ng t l quy nh, nu ly sai phi ly li.
_ Natricitrat khng dng cho cc cc XN ha sinh v lm thay i kt qu cc XN do:
+) Gim gi to Ca2+ - Tng gi to Na+
+) c ch ALP , ALT
+) Thay i kt qu nh lng Phosphate
L VN CNG
94
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
_Cac thuc chng ng ng ung l cac cht khang VTM K , thng l cac thuc dn
xut ca Coumarin ( Wafarin )
_ Thuc c ch s hot ng ca VTM K Qua c ch cac yu t ph thuc VTM K
khi hot ha: II , VII , IX , X , PC , PS Cac yu t ny c tng hp nhng khng c
kh nng hot ha
_ C ch c ch VTM K din ra nh sau : Thuc c ch enzyme epoxyd reductase , t
lm tng t s oxyd/vitamin K . Lng oxyd nhiu s cnh tranh vi VTM K vng th
cm lm VTM K b gim hiu lc.
V. ASPIRIN
_ Aspirin v cac thuc chng vim khng steroid (NSAID ) c tac dng chng kt tp tiu
cu , bng cach c ch TC gii phng ra yu t Thomboxan A2 v ADP .
_ C th nh sau : Aspirin c ch men cyclo-oxygenase ngn cn hnh thnh Thomboxan
A2nh c ch s ngng tp TC
L VN CNG
95
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
Gi tr bt thng
>450 G/L
< 100 G/L
>6
_ Cc mau khng co
_ Cc mau co khng hon ton
_ Cc mau b nat
> 15
> 60s so vi chng
( > 330)
> 8s ko di ( >48s )
> 20s bnh l ( >60s )
> 1.2
> 2s so vi chng ( >16s )
> 1.15
< 60% ( ko di )
> 5s so vi chng ( >25s )
> 1.15
<15 TSH cp
15-30TSH nng
30-45TSH va
45-60TSH nh
(+)
> 10 g/ml
< 1 g/l
96
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
THE END
L VN CNG
97
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
L VN CNG
98
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
MC LC
I-CM MU BAN U
3. Cc yu t tham gia CMB10
4. Cc XN nh gi CMB.12
_ Nghim php dy tht12
_ Thi gian mu chy ( PP Duke )...13
_ XN co cc mu...14
II- NG MU
4. iu ha qu trnh M-Cc yu t tham gia.15
5. Cc giai on ca qu trnh ng mu19
6. Cc XN kho st qu trnh ng mu.24
_ Thi gian mu ng trn lam.24
_ Thi gian mu ng trn ng nghim..25
_ Thi gian Howell26
_ Thi gian APTT.27
_ Thi gian TT...33
_ Bng tm tt cc XN ng mu34
L VN CNG
99
Khoa xt nghim i hc k thut y t Hi Dng
CM NANG HUYT HC NG MU
IV- BNH NG MU
13.Hi chng ng mu ri rc lng mch (DIC)..71
14.Hi chng xut huyt gim tiu cu huyt khi (TTP).74
15.Hi chng tan mu Ure huyt cao (HUS).75
16.Tnh trng tng ng-Bnh huyt khi..77
17.ng mu thai nghn...82
18.Bnh Hemophilie ..83
19.Bnh ri lon ng mu mc phi.85
_ Thiu VTM K85
_ Bnh gan.86
_ Bnh h thng Lupus ban (SLE).87
_ Ri lon ng mu sau truyn mu d tr t89
_ Bnh vim thnh mch d ng89
20.Bin lun xt nghim ng mu.90
21.Cc gi tr M cho cuc m an ton. 91
22. Tm hiu c ch v ng dng mt s cht-thuc chng ng
_ Heparin..92
_ Natricitrat..92
_EDTA ( Ethylene diamin tetraacetic acid )..93
_ Wafarin ( thuc c ch VTM K ng ung )94
_ Aspirin.94
23.Bng tr s bnh thng-bt thng ca cc XN ng-cm mu.95
24.Tr s bnh thng ca cc yu t tham gia ng-cm mu v TSH.96
L VN CNG
100
Khoa xt nghim i hc k thut y t Hi Dng